Background. Three-dimensional (3D) photography provides a promising means of breast volumetry. Sources of error using a single-captured surface to calculate breast volume include inaccurate designation of breast boundaries and prediction of the invisible chest wall generated by computer software. An alternative approach is to measure differential volume using subtraction of 2 captured surfaces. Objectives. To explore 3D breast volumetry using the subtraction of superimposed images to calculate differential volume. To assess optimal patient positioning for accurate volumetric assessment. Methods. Known volumes of breast enhancers simulated volumetric changes to the breast (n = 12). 3D photographs were taken (3dMDtorso) with the subject positioned upright at 90° and posteriorly inclined at 30°. Patient position, breathing, distance and camera calibration were standardised. Volumetric analysis was performed using 3dMDvultus software. Results. A statistically significant difference was found between actual volume and measured volumes with subjects positioned at 90° ( P < .05). No statistical difference was found at 30° ( P = .078), but subsequent Bland–Altman analysis showed evidence of proportional bias ( P < .05). There was good correlation between measured and actual volumes in both positions (r = .77 and r = .85, respectively). Univariate analyses showed breast enhancer volumes of 195 mL and 295 mL to incur bias. The coefficient of variation was 5.76% for single observer analysis. Conclusion. Positioning the subject at a 30° posterior incline provides more accurate results from better exposure of the inferior breast. The subtraction tool is a novel method of measuring differential volume. Future studies should explore methodology for application into the clinical setting.
Introduction
Simulation training is increasing in popularity within the medical field. It provides a safe, reproducible environment in which learners can build upon surgical skills. The current pandemic has reduced workplace opportunities for learning, with decreased theatre opportunities and a high volume of trainees seeking training. In order for realistic skill development synthetic substitute materials have a role in facilitating training of suturing, excision, local flaps and other skills. The aims of this review were to compare commercially available synthetic materials for use in remote surgical skill training.
Methods
8 commercially available skin substitutes were included in this review; felt, foam dressing, a generic silicone skin pad, Sigma Lance Basic, Sigma Lance Advanced, Sigma Lance Infinity, Suture Doctor, and Limbs & Things. A questionnaire was distributed to 30 medical students, surgical trainees and consultants consisting of 8 criteria pertaining to surgical skills and similarity to skin. Cutometry and durometry data was obtained and compared to skin on the face, arm and back of 3 healthy participants under the age of 30.
Results
Overall, felt had the poorest outcomes in all domains. Foam dressing was comparable to skin on the face, back and arm for both cutometry and durometry. Foam dressing was comparable to commercially available skin pad results in the questionnaire.
Conclusion
Foam dressings are comparable to commercially available skin pads in application of surgical skills, and are a cost-effective alternative to facilitate delivery of remote training of surgical trainees.
Take-home message
Foam dressings constitute an alternative, comparable and cost-effective synthetic material for remote surgical skill development, particularly suturing, excision and local flap design.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.